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Construction and Implementation of Information System for TPA Department

  • Indu Dhangar
  • Agency : TPA Department, Information System, Hospital Information System
  • Objective : This project is envisaged to enhance the productivity and improvement in the operational efficiency of the functions routinely performed in TPA department and reducing the time lag for getting information to take key decisions.
  • Background : Not Available
  • Methodology : Implementation of HIS was done in six phases and the method of data collection was observational and discussion with end users. Total expenditure on health in India is nearly 6% of the entire GDP. Indian health insurance industry stands at INR 5,125 crores with only a small section of the total population  (around 2%) covered so far. CAGR of this sector is around 35% (FY 2002 08). This shows that the health insurance industry is one of the largest and fastest growing of all human activities. This huge growth has led to the development of a number of third party administrators to manage the client base. Currently there is 36 TPAs working for different insurance companies.
  • Findings : CFS is in the panel of 31 TPAs and thus it can serve most of the insured patients. As the number of TPAs and PSUs that are in the panel of CFS is large, keeping a track of all the cases, payments and outstanding bills is very important to maintain the financial integrity of the organization. The hospital is already having a hospital information system (HIS) package that starts by the word 'i-care.' the HIS caters to the front office operations like appointment ,IP and OP billing, registration, pharmacy, examination, etc. However, back office operations like procurement, accounts payable, accounts receivables, TPA receivables and outstanding payments etc. could not be carried out through the HIS and documents related to these processes exist in independent files and folders on a shared documentation basis in the back office systems. The lack of automation for these processes and the 'disconnect' with HIS lead to delays in monthly stock reconciliation, financial status information, profitability analysis and cost center accounting.
  • Recommendations : The need of the hour is streamlining of all the hospital activities related to the interaction with TPA vis pre- authorization, query reply, approval status, claim settlement, TPA receivables and outstanding reconciliation. In this study , work is done mainly on time saving activities for getting the approval, enlightening the patients about their roles and responsibilities related to Cashless hospitalization and introduction of information system in order to improve the process of tracking financial data , its storage , retrieval and reconciliation..
to enhance the productivity and improvement in the operational efficiency of the functions routinely performed in TPA department